What is GERD?
Gastroesophageal Reflux Disease (GERD), or reflux disease, is a very common disease of the digestive system resulting from a failure of the barrier at the lower end of the esophagus, the lower esophageal sphincter (LES).
What Causes Heartburn?
It starts with the lower esophageal sphincter (LES), a ring of muscle that is located at the bottom of the esophagus. While the esophagus carries food from the mouth to the stomach, the LES functions as a valve between the two.
How the LES functions
In a healthy individual not suffering from GERD, the LES acts as a barrier, essentially squeezing the lower esophagus closed and keeping stomach contents from refluxing upward into the esophagus. When the LES opens when it’s not supposed to, what causes heartburn is the highly acidic contents of the stomach reaching the esophagus and irritating the outer membrane. Occasional reflux generally doesn’t cause problems (other than the uncomfortable symptoms), but when it happens repeatedly over time, it can damage the LES to the point it no longer functions effectively as a barrier, resulting in GERD.
What causes the LES to degrade?
The LES can degrade or function abnormally due to a variety of causes, such as overeating, hiatal hernia, pregnancy, and chemicals in certain foods.
To see how this damage occurs, let’s look at how chronic overeating affects the LES. Inappropriate portion sizes cause the stomach to distend, which in turn puts excess pressure on the LES. This pressure changes the shape of the LES and causes exposure to stomach acid. If stomach acid regularly enters the LES, it may become damaged to the point where it can no longer generate enough pressure to squeeze the lower esophagus closed. Over time, the extra pressure can also shorten the LES, further reducing its ability to act as a barrier. There are other proposed mechanisms as well.
Over time, frequent reflux results in significant reduction in the length of the LES as well as its ability to generate the necessary pressure to prevent reflux. Once the barrier is gone, the damage can be permanent, although
When the LES is weak or mildly damaged, you may experience still reflux. The more the LES weakens, the more often you will experience reflux symptoms. And the more you reflux, the weaker the LES becomes over time. However, many adults suffering from GERD who have been overweight for a period of time have realized complete elimination of symptoms after achieving a healthy BMI. It is difficult to determine if an LES is permanently damaged or simply weak. Remember, GERD develops when the LES is unable to do its job effectively.
The importance of behavior change
While certain potential causes of reflux, such as pregnancy, are not unhealthy, many reflux-inducing behaviors, such as overeating, should always be avoided. Eating supersized portions, for example, has numerous adverse health effects and puts you at severe risk for GERD. Regularly consuming large meals increases your likelihood of becoming obese, which makes you 3 times more likely to have GERD than those who are not obese.
GERD is a long-term condition that varies in severity among sufferers. GERD does not get better without positive lifestyle changes. If you are suffering from GERD, your goal should be to contain the disease and improve the quality of your life. Adopting a GERD-friendly diet and eating 5 or 6 small meals every day can help as well. If your BMI is greater than 24, you can reduce the pressure on both your LES and your diaphragm by losing weight. We encourage everyone to learn more
If you still have questions concerning what causes heartburn, be sure to visit the Mayo Clinic patient website. Right now, however, we want you to begin taking control of your health by taking our GERD Stage Assessment and downloading recommendations to help you take control of your symptoms. Our 18-page personalized report will provide you everything you need to get a start on building your plan for relief and good health.
Reviewed by: Dr. Dengler, RefluxMD Medical Director